目的:有症状的二尖瓣疾病不适合修复的患者可以通过手术二尖瓣置换术(MVR)充分治疗。生物和机械MVR(bMVR/mMVR)之间的决定可能很困难,特别是由于两个害处较轻的问题:抗凝与再手术。
方法:这种单中心,回顾性研究纳入了2001年至2020年期间接受MVR的所有患者.分析30天死亡率和围手术期并发症。根据年龄调整的倾向得分匹配(PSM),性别,体重,高度,心内膜炎,糖尿病,高血压,PAOD,AFib,CKD,癌症,并进行了神经系统疾病的病史。PSM之后,分析随访时的生存率和再手术的累积发生率.
结果:该研究包括两个主要组的2,027名患者:1,658名bMVR患者,369例mMVR;51.2%为男性。手术年龄为65.9±12.9岁。中位随访时间为6.83年(IQR1.11-10.61年)。1,467例(72.4%)进行了伴随手术。PSM产生了339对的可比组。两组均显示出相当的生存率(p=0.203)。mMVR和bMVR后的存活率在20年的过程中对于所有分析的时间点是相当的。mMVR患者的再手术累积发生率显着降低(20年:15%vs.59%,p<0.001)。
结论:在高容量中心进行的20年随访证明机械或生物二尖瓣置换术(MVR)后的生存率相当,而mMVR后再手术率显着降低。
OBJECTIVE: Patients with symptomatic mitral valve disease unsuitable for repair can be sufficiently treated with surgical mitral valve replacement (MVR). The decision between biological and mechanical MVR (bMVR/mMVR) can be difficult, especially due to the question of the lesser of two evils: anticoagulation versus reoperation.
METHODS: This single-center, retrospective study included all patients undergoing MVR between 2001 and 2020. Thirty-day mortality and periprocedural complications were analyzed. Propensity-score matching (PSM) adjusted for age, gender, weight, height, endocarditis, diabetes, hypertension, PAOD, AFib, CKD, cancer, and history of neurological disorders was performed. After PSM, survival and cumulative incidence of reoperation at time of follow-up were analyzed.
RESULTS: The study included 2,027 patients in two main groups: 1,658 patients with bMVR, and 369 with mMVR; 51.2% were male. Age at surgery was 65.9±12.9 years. Median follow-up time was 6.83 years (IQR 1.11-10.61 years). Concomitant procedures were performed in 1,467 cases (72.4%). PSM yielded comparable groups of 339 pairs. Both groups showed comparable survival (p=0.203). Survival after mMVR and bMVR was comparable for all analyzed time points over the course of 20 years. Patients with mMVR showed a significantly lower cumulative incidence for reoperation (20-year: 15% vs. 59%, p < 0.001).
CONCLUSIONS: Follow-up of 20 years at a high-volume center demonstrates comparable survival after mechanical or biological mitral valve replacement (MVR), while reoperation rates are significantly lower after mMVR.